Support and Insurance FAQs
- Is REMICADE® covered by my insurance plan?
- Why does insurance coverage vary so much?
- Does Medicare cover treatment with REMICADE®?
- Does Medicaid cover treatment with REMICADE®?
- I am on a managed care plan. Will my treatment with REMICADE® be covered?
- How do traditional health insurance plans provide coverage for REMICADE®?
- I called my insurance company, but I still have questions about paying for REMICADE®. Who can help?
- Are there other sources of financial help I can look into?
Is REMICADE® covered by my insurance plan?
Treatment with REMICADE® is covered by most insurance plans, as well as Medicare and Medicaid. Just remember that coverage policies may vary by insurer, by individual, or even between plans offered by the same insurer.
Why does insurance coverage vary so much?
Your insurance coverage can vary for many different reasons, including:
- Whether your doctor is part of your health plan (e.g., “in network” vs “out of network”)
- The location where you get therapy with REMICADE® (e.g., doctor's office, home infusion setting, or hospital outpatient department)
- The rules for preauthorization or referral forms for visits to outpatient departments or medical specialists
If you have any questions about insurance coverage or reimbursement, you should first call your insurance company or Medicare.
Does Medicare cover treatment with REMICADE®?
Medicare carriers and the claims processors for all states cover infusions of REMICADE® in doctors' offices and hospital outpatient facilities. The traditional Medicare Fee-for-Service Program does not cover infusions of REMICADE® when they are provided by home infusion companies or retail pharmacies.
Does Medicaid cover treatment with REMICADE®?
Medicaid also covers infusions of REMICADE®, but coverage may be restricted to certain treatment settings or may require precertification.
I am on a managed care plan. Will my treatment with REMICADE® be covered?
Most managed care plans—such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs)—cover treatment with REMICADE®. Managed care plans typically require that you share some of the cost of infusion therapies. In general, these plans are likely to require precertification and completion of referral forms for specialist care. They may also limit the choice of providers from whom you may obtain treatment.
How do traditional health insurance plans provide coverage for REMICADE®?
These plans usually cover therapy with REMICADE®. Typically, this insurance offers coverage for a wider range of services, but with a higher level of copayment than a managed care organization. Precertification or prior authorization is usually not required.
I called my insurance company, but I still have questions about paying for REMICADE®. Who can help?
If you need additional information related to medical coverage for REMICADE®—or if you have other questions or concerns—call AccessOne® at 1-888-ACCESS-1 (1-888-222-3771) for assistance.
Are there other sources of financial help I can look into?
Yes. There are many sources of public and private financial support available to people who need help paying for their medical treatment.
In some cases, certain foundations provide support specifically for people who are being treated for a particular disease.
Only your doctor can recommend a course of treatment after checking your health condition. REMICADE® (infliximab) can cause serious side effects such as lowering your ability to fight infections. Some patients, especially those 65 years and older, have had serious infections caused by viruses, fungi or bacteria that have spread throughout the body, including tuberculosis (TB) and histoplasmosis. Some of these infections have been fatal. Your doctor should monitor you closely for signs and symptoms of TB during treatment with REMICADE®.
Unusual cancers have been reported in children and teenage patients taking TNF-blocker medicines. Hepatosplenic T-cell lymphoma, a rare form of fatal lymphoma, has occurred mostly in teenage or young adult males with Crohn’s disease or ulcerative colitis who were taking REMICADE® and azathioprine or 6-mercaptopurine. For children and adults taking TNF blockers, including REMICADE®, the chances of getting lymphoma or other cancers may increase.
You should discuss any concerns about your health and medical care with your doctor.
What should I tell my doctor before I take REMICADE®?
You should let your doctor know if you have or ever had any of the following:
- Tuberculosis (TB) or have been near someone who has TB. Your doctor will check you for TB with a skin test. If you have latent (inactive) TB, you will begin TB treatment before you start REMICADE®.
- Lived in a region where certain fungal infections like histoplasmosis or coccidioidomycosis are common.
- Infections that keep coming back, have diabetes or an immune system problem.
- Any type of cancer or a risk factor for developing cancer, for example, chronic obstructive pulmonary disease (COPD) or had phototherapy for psoriasis.
- Heart failure or any heart condition. Many people with heart failure should not take REMICADE®.
- Hepatitis B virus (HBV) infection or think you may be a carrier of HBV. Your doctor will test you for HBV.
- Nervous system disorders (like multiple sclerosis or Guillain-Barré syndrome).
Also tell your doctor if you:
- Use the medicines Kineret (anakinra), Orencia (abatacept) or Actemra (tocilizumab) or other medicines called biologics used to treat the same problems as REMICADE®.
- Are pregnant, plan to become pregnant, are breast-feeding, or have a baby and were using REMICADE® during your pregnancy. Tell your baby’s doctor about your REMICADE® use before the baby receives any vaccine because of an increased risk of infection for up to 6 months after your last dose of REMICADE® you received during your pregnancy.
- Adults and children should not receive a live vaccine while taking REMICADE®.
What should I watch for and talk to my doctor about before or while taking REMICADE®?
The following serious (sometimes fatal) side effects have been reported in people taking REMICADE®.
You should tell your doctor right away if you have any of the signs listed below:
- Infections (like TB, blood infections, pneumonia)—fever, tiredness, cough, flu, or warm, red or painful skin or any open sores. REMICADE® can make you more likely to get an infection or make any infection that you have worse.
- Lymphoma, or any other cancers in adults and children.
- Skin cancer—any changes in or growths on your skin.
- Heart failure—new or worsening symptoms, such as shortness of breath, swelling of your ankles or feet, or sudden weight gain.
- Reactivation of HBV—feeling unwell, poor appetite, tiredness, fever, skin rash and/or joint pain.
- Liver injury—jaundice (yellow skin and eyes), dark brown urine, right-sided abdominal pain, fever, or severe tiredness.
- Blood disorders—fever that doesn’t go away, bruising, bleeding or severe paleness.
- Nervous system disorders—numbness, weakness, tingling, changes in your vision or seizures.
- Allergic reactions during or after the infusion—hives, difficulty breathing, chest pain, high or low blood pressure, swelling of face and hands, and fever or chills.
- Lupus-like syndrome—chest discomfort or pain that does not go away, shortness of breath, joint pain, rash on the cheeks or arms that gets worse in the sun. The more common side effects with REMICADE® are respiratory infections (that may include sinus infections and sore throat), headache, rash, coughing and stomach pain.
- Psoriasis—new or worsening psoriasis such as red scaly patches or raised bumps on the skin that are filled with pus.
You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.